The musings of a birth teacher

Before the 1950's it wasn’t uncommon for obstetricians to wait at least five minutes before clamping and cutting. It was just after the 60's that delayed cord clamping was thought to have no benefit and the timing of the cord was shortened. Today, the majority of obstetricians cut the cord in the first 15 seconds of the baby’s birth. Many providers have been taught that this is the way it should be done, and more importantly they were taught that it could be detrimental to the mother or baby if they waited longer - despite any evidence to back up those concerns. As new research has come out over the past several years, there has been much resistance. Part of this is due to the fact that cutting the cord immediately allows for a faster delivery of the placenta (and subsequently they get out of the deliveryroom faster too), and partly because it’s hard to undo years of negative misconceptions (i.e. the baby will be more likely to become jaundiced, the baby might get polycythemia, and/or receive too much blood).

Things are changing, and more and more research is coming out, and it’s getting harder for providers to ignore the evidence and not provide delayed cord clamping in normal birth situations. We are starting to see guidelines being set due to the overwhelming evidence that the benefits of delaying cord clamping outweigh any potential risks. In fact, those who are still hesitant to start implementing this practice are being asked to show their burden of proof to the contrary. So who are these organizations out there are changing their guidelines?

The World Health Organization: WHO has has endorsed delayed cord clamping of at least 1-3 minutes for the past several years.

The Neonatal resuscitation program (which is developed and maintained by the American Academy of Pediatrics and is the gold standard in all US hospitals for providers who care for babies immediately after birth): In June of 2016, the Neonatal Resuscitation Program revised and updated their guidelines. “Evidence suggests that cord clamping should be delayed for at least 30 to 60 seconds for most vigorous term and preterm newborns.”

Finally, ACOG had to back up the guideline and issue new practices: In December of 2016, ACOG (The American College of Obstetricians and Gynecologists), released it’s recommendations that all doctors and midwives delay the cord clamping for a minimum of 30-60 seconds for all healthy newborns.

In the United States we think of this as a new practice, but some countries have been doing this much longer. For example, in the UK, the National Institute for Health and Care Excellence (NICE) changed its guidelines back in 2012. They stated that doctors and midwives should not routinely clamp the cord ‘earlier than one minute from the birth of the baby’, and instead should wait one to five minutes - and longer if the mother requests it. (Studies showed that 53% of surveyed providers in the UK routinely delay cord clamping/cutting already in 2009).Here in the DFW metroplex, almost all midwives (including those who work in hospitals), and many OB’s support delayed cord clamping. We get change by asking, and helping providers understand “myth-conceptions”. We have not only seen change, but also improvements, such as delaying cord clamping/cutting in the OR during cesarean births in several hospitals (with certain providers) in our area!

What are the potential risks?

There may be a slight increase in billirubin levels increasing the chances of needing phototheraphy for neonatal jaudice. Studies range from “no significant difference” to ‘a slight increase’ in the risk of jaundice. A study (McDonald and Middleton's), found that 3% of babies who experienced early cord clamping, compared to 5% of babies who experienced delayed cord clamping required treatment for jaundice. Despite the increased risk, WHO, ACOG and many other organizations around the world state that ‘the benefits of delayed cord clamping outweigh the risks of jaundice’.

What medical circumstances might interfere with your decision to do delayed cord clamping?

The World Health Organization states that delayed cord clamping in under a minute should occur “when a newly born term or preterm babies require positive-pressure ventilation, the cord should be clamped and cut to allow effective ventilation to be performed.” - And/or - "newly born babies who do not breathe spontaneously after thorough drying should be stimulated by rubbing the back 2–3 times before clamping the cord and initiating positive-pressure ventilation.” Basically this means that anytime a term baby is born, it should be given the opportunity to cry while being dried and stimulated on the mother’s belly for at least a few seconds before clamping and cutting the cord and handing it over to the NICU team for more care.

A preterm baby may not get even a minute depending on how small they are,and how they are reacting immediately after birth. If a preterm baby is doing well, it is extremely beneficial to delay clamping the cord.

Sometimes providers will not delay cord clamping/cutting when there is thick meconium present at birth. Many providers are more comfortable handing the baby over to the NICU team immediately after birth so that they can start suctioning the baby’s mouth and throat before vigorous crying occurs. However, the newest Neonatal Resuscitation guidelines (starting in 2015), state this protocol: “Non-vigorous newborns with meconium-stained fluid do notrequire routine intubation and tracheal suctioning; however, meconium-stained amniotic fluid is a perinatal risk factor that requires presence of one resuscitation team member with full resuscitation skills, including endotracheal intubation.” Most babies come out crying before suctioning can be done, so many hospitals are now taking a ‘wait and see’ approach and suctioning well after birth if it is needed.

The United States would be wise to implement a table such as the LifeStart where bedside resuscitation can occur while keeping the umbilical cord attached. Birth centers and home birth midwives already have this practice in place, by having portable oxygen nearby. Instead of bringing baby to the oxygen equipment, they bring the equipment to the baby! Hospitals across the globe are using the LifeStart (or other similar tables) for bedside resuscitation, why can't we?

What non-medical reasons are there for cutting the cord early?

The main reason for implementing this practice is care providers preference. According to the study “Attitude of obstetricians towards delayed cord clamping: A questionnaire-based study” published in July of 2009 by Ononeze & Hutchon (1) - the main reason for not doing it? “Difficulty with implementation in clinical practice”. Hmmmm. I’m not sure why it’s harder to hand the baby to it’s mother and wait a few short minutes, but my bet is on the fact that waiting is boring and time consuming. (Oops, did I just get cynical?)

Some providers are still hesitant because of the myths that have been perpetuated through the years (stated in the first paragraph). I truly believe that they feel it is very unsafe to implement this practice (and I’ve heard some go as far as to tell clients that they have seen baby’s go to the NICU because of it)! Any provider who says that it is NOT safe or not beneficial to delay cord clamping needs to challenged to come up with a recent study as to why it is NOT safe orbeneficial. (They can’t). There are some that will refuse to implement this practice at all, while others will say they will only to change their minds during the birth. A few more are likely to meet you somewhere in the middle. Some will say they can “milk the cord” for a few seconds (no proven benefits), some will be okay with a 30-60 second delay. More often than not, from what I have seen, more than half of the providers that say they will wait, end up finding a reason to cut it sooner anyway.

Cord blood banking may be another reason delayed cord clamping can’t/won’t be done. Most cord blood banking companies require a specific amount of blood in order to bank it - and this requires cutting and clamping the cord sooner. There *are* some cord blood banks that can bank a much smaller amount and claim that parents may be able to delay up to a full 2 minutes. It is never a guarantee that you will get both, so make sure you have a final decision to do one or the other if it comes down to it, so you don’t have to make that split-second decision!

Are there any medical reasons for cutting the cord early?

Yes, there are medical circumstances that may require more focus on the mother or baby. For example, placenta abruption, or even if the placenta is partially (and prematurely) separating from the uterus. When this happens, there is less oxygen transferring to baby, and baby may not benefit much or at all from the cord staying intact anyway. In some cases, the mother and baby may both need attention separately.

When is the ideal time to cut when both mom and baby are doing fine?

When the cord stops pulsating - or at least 3 minutes after birth. It's pretty easy to tell when it's time to cut the cord. First of all, you can feel for a pulse by squeezing the cord near your baby's belly 'button'. You can also see the changes as well: At first, the cord is dark blue and coiled like an old fashioned telephone cord and you can feel the pumping easily with your fingers. As the blood supply drains from the placenta into your baby, the cord becomes white and flat while the pulse in the cord becomes weak until non-existent. A great visual can be found here: https://www.nurturingheartsbirthservices.com/blog/?p=1542

If your provider is still hesitant, don't be afraid to find out what their concerns are. Have they read the updated guidelines, and if so, why are they not implementing them yet? Can they meet you somewhere in the middle? How strongly do you feel bout this? Would you switch care providers if they are against delayed cord clamping in normal birth situations? Tell me your thoughts below!

References:(1) “Attitude of obstetricians towards delayed cord clamping: A questionnaire-based study” published in July of 2009 by Ononeze & Hutchon -www.tandfonline.com/doi/full/10.1080/01443610802712918?scroll=top&needAccess=truehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1564438/http://www.medicalnewstoday.com/releases/70525.phpDowney C, Bewley S Third stage practices and the neonate. Fetal and Maternal Medicine Review 2009;20:229–46http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Delayed-Umbilical-Cord-Clamping-After-Birth

More reading:https://www.scienceandsensibility.org/p/bl/et/blogid=2&blogaid=526http://www.bellybelly.com.au/birth/delayed-cord-clamping/See my Pinterest board on delayed cord clamping for more reading and video resources!

Sherpas are regarded as elite mountaineers and experts in guiding people through the most treacherous of mountain terrains. Even expert mountain climbers hire Sherpas for serious mountain climbing such as trekking the Himalayas or climbing Mt. Everest. Do they have to? No, but word gets around fast; Hiring a Sherpa will make the experience so much easier. Sherpas can be invaluable to making the experience safer and more pleasant. Doulas are birth Sherpas. We know birth inside and out. We walk families through the process from start to finish. We are experts you can lean on in every situation, every step of the way. Partners aren’t left to stare at a map and try to figure out which move to make next, their Sherpa knows all the pathways and alternate routes already.

Let’s say your goal is to climb to the top of a huge mountain such as Everest. You learn all that you can. You take classes, you poor through books, and even watch some videos. Sometimes that is enough. What if while doing your homework, you polled everyone that climbed that mountain and discovered that most people had trouble making it to the top on foot without the help of a Sherpa? What if you found that the people who hired a Sherpa were much happier with their experience? Less likely to need medical help? Hiring a doula is very much like that and more. Studies show that when a woman receives continuous support from a doula, they are more likely to have spontaneous vaginal births, less likely to have pain medication, vacuum or forceps-assisted births, negative feelings about childbirth, and their chances of having a cesarean were greatly reduced! In addition, their labors were shorter, Pitocin augmentation was used less, and their babies fared better, having higher APGAR scores at birth, and lower NICU transfers.

So why can’t your mother or partner “be the doula” and do the same thing? Well, those studies were done, and for some reason the studies did not provide the same outcomes. In fact best results occurred when women had continuous support from someone NOT from the mother’s social network or even provided by the hospital staff. --2012, Hodnett et al. It’s easy to understand why, but perhaps I’ll leave that for another day. The bottom line is doulas know birth. They are the birth Sherpas of this world. They have climbed that mountain many times and know so many tricks to make it a safer and easier journey.

You might be thinking – “well what if I don’t want to take the long hard trek up the mountain”? “What if I want to take the elevator and enjoy the view once I get to the top”? “Why would I need a doula for that”? The answer is simple. Even if you want an epidural, or even an elective cesarean, a doula can help you plan for the safest passageway to the top. She knows some awesome things that will make the view on the way up much more pleasant and beautiful. She is there if the elevator gets broken and you have to climb to the top via the stairs, or even through the mountainous terrain. Yeah that happens sometimes!

No matter how you climb that mountain, your life has changed forever. Birth changes you. Being a parent changes you. You have a tiny new human to feed and carry home. Your doula will most likely come to your home at least once after the birth to check on you and help provide those last minute resources, tips and tricks to get your footing again. If parenting in those early weeks scares you more than climbing Mt. Everest, than consider a postpartum doula to help ease your transition in those early weeks too! Yeah, there’s a doula for that too!

Some people think that being a doula is all flowers and rainbows....I.wish.

I was once asked why doulas charge so much, because (and I quote), "you don't do anything". My heart sank that this first time mom had no clue how hard we work, and how much we have to sacrifice to do what we do. Being a doula is the most rewarding job I have ever had, but it's not the easiest one. I do it because I love it, but I also do it to keep a roof over my children's heads.

I don’t think that people realize that we have so much work that needs to be done prior to the birth; spending hours a week working hard at keeping our business up and running. Website, social media, blogging, networking, answering emails, interviewing potential clients, and answering texts and phone calls are among the long list of things we also do beyond those birthing doors. Clients often forget that if we don’t make ourselves known, we wouldn’t be there to serve them in the first place. We have a bona fide business to run with real taxes to pay!

Today I'm going to give you a glimpse into what being a doula is really like. This is the real stuff. The hard stuff, and the reasons why we charge what we do.

BEING A DOULA REALLY MEANS......

Carrying your phone around with you every where you go. 24.7.

Planning a family vacation months in advance. (Knowing that for every day you are gone, you’ll lose potential clients and income. There is no paid vacation time).

Standing for hours on end during a birth. (Swollen legs come with the job).

Postponing Thanksgiving, Easter or other holiday's when a baby decides to come instead.

Providing counter pressure for hours on end. The real kicker? The longer it goes, the harder you need to do it (if she is trying to go unmedicated).

Driving through torrential rains because babies often come when a storm system moves in.

Holding the barf bag in one hand, while holding her hair back with the other.

Paying out of pocket for your own health insurance because you own your own business. (Especially true for doulas who are single, or have disabled husbands, etc).

Wiping sweat, blood or other bodily fluids off her body.

Leaving a birth, looking forward to a hot meal and shower only to be called half way home. You have to turn around and head to the next one.

Putting yourself in danger as you walk in the empty parking lot or streets to get to your car in the middle of the night.

Paying outrageous toll fees in the middle of rush hour so that you can get to her a little faster.

Rubbing her back, legs, etc - all night long.

Sheepishly accepting an invitation with the caveat: "I'll be there unless I am at a birth".

Being up all night at the ER with your child or husband only to get called to a birth as soon as you get home - knowing that you may very well not sleep until TOMORROW morning

Wishing you could answer the question “how much longer do I have”?

Coming to the realization that the longer and harder your work, the less you get paid.

Being a doula is hard work people! It doesn't matter how long or short the birth is, or how much work she does - a doula will always sacrifice something by simply being on call for her clients. Please, go hug a doula today!

Parenting a newborn is tough. Not only do you feel like you are setting a record for lack of sleep, you have this tiny baby doing freaky things that contribute to that lack of sleep. This of course, leads to a whole new level of anxiety that you didn’t think was possible. First of all breathe! Many of those newborn concerns turn out to be completely normal. Let’s take a look at the top five things that freak new parents out:

Newborn rash:

Your baby starts breaking out in little ‘hives’ all over his/her body. Immediate panic sets in as you Google “rashes” with one hand and call the doctor with the other. The newborn rash, (erythema toxicum) is super common and affects about 50% of all newborns. It typically shows up between days 3-5 after birth, lasts about a week (but can stick around as long as 4 months), and no treatment is necessary. It doesn’t seem to bother them, but it sure can worry new parents!

Note: It never hurts to double check with your pediatrician to make sure you’re not dealing with a rash that can occur due to serious illnesses. This is especially true if your baby seems lethargic, is running a fever or simply not his/her usual self.

Blood coming from her vagina:

I’m not talking about mom’s vagina, which of course would be expected after delivery. I’m talking about your newborn daughters vagina. Yeah, it happens. It can be perfectly normal to see bleeding or even vaginal discharge (physiologic leukorrhea) for about a week - usually starting around the 3rd day of her life. This strange phenomena caused by the withdrawal of the hormones she was exposed to in the womb.

Note: It’s okay to talk to your pediatrician about what is normal and what is not. For example, he/she may tell you to let them know if it isn’t gone by a certain amount of time, or it is starts to have a foul odor.

Milk coming out of his/her breasts:

Boy or girl, it doesn’t matter! About 5% of all newborns will produce what we call “witches milk.” The technical term is called galactorrhea. This is simply caused by the mother’s hormones that were passed to baby before birth. This is usually gone by two weeks, but about 2 % will ‘lactate’ for up to two months. You may also notice larger breast nodules on your baby during this time too. No treatment is needed, but do watch for signs of infection.

Note: Redness, increased swelling, and/or fever may indicate your baby has mastitis, so take him/her into the pediatrician if this occurs. I guess it should go without saying, that you should NOT do anything to get the milk out. Please leave it alone. No massage, or expression of milk please. Seriously, folks, let it be.

Brick Dust (orange, pink or red colored urine in the diaper):

In the first two-three days of life, your baby may be slightly dehydrated and this may cause a pink, red, or orange-colored, powdery stain in your baby's diaper called brick dust. It looks like there might be blood in the urine, (though it's technically not) and is caused by a build up of uric acid crystals. Parent's may also see a powdery substance (hence the name "brick dust"). Usually, once the mother's milk comes in, it should quickly disappear, not to be seen again.

Please note: This highly concentrated urine is okay in the first few days of life, but do take in the following considerations:

Are you still seeing brick dust after day 4 of life? (Contact a provider).

Breathing all kinds of funky:

While an adult averages between about 16-20 breaths per minute, a newborn baby may average between 30 and 50 breaths per minute. This faster breathing is also accompanied by some erratic behavior; Quick breathing, followed by slow breathing and a few seconds of holding their breath is common. (They just want to see you wet your pants a little). As adults, we tend to breath fairly smooth and rhythmic, but watching a newborn breath can certainly turn your hair gray fast.

Please note the following signs may need to be addressed immediately by either calling 9-1-1 or a making a trip the closest ER:

If the area around your baby’s mouth or lips turns gray or blue

Chest retraction

Nasal flaring

Persistent grunting with each breath

It's important to note that talking to your pediatrician is always a good idea, (that's what they are there for), and listen to those parenting instincts. Another helpful tip is to talk to your labor and delivery nurse, (or midwife) about what to expect in the early days at home, so that you are more prepared.

There are many other freaky newborn things that will most likely concern you, so consider taking a newborn class, or pick up a book or two on newborn basics.

What freaked you out as a new mother or father? Please feel free to post your stories or comments below!

P.SYou might want to go ahead and put some money aside for washing the gray out of your hair!

Medical Disclaimer:The information on this website and blog is meant for basic informational purposes only. It is not intended to serve as medical advice or treatment. Readers are advised to consult with their doctor or midwife before making any decisions concerning their baby's health.

Belly binding after birth is becoming more and more popular, and although the this practice has been around for thousands of years, we in the United States are just hearing about it - mainly thanks to the advertising and marketing of company’s such as Belly Bandit®. Hospitals are handing out various types of binds, and word is getting around about the benefits and wonderful support that belly binding can provide.

Since there are so many methods and binds out there, I thought I’d show a comparison between Bengkung belly binding and the more modern binds sold online and in stores. I’ll save a post about the benefits of belly binding for another day (or you can read the cliff notes here). Let’s face it, you probably wouldn’t be here if you weren’t curious, or weren’t considering using a wrap of some kind. You’re just trying to figure out what kind is best! So without further ado, let’s get into the differences between Bengkung Belly Binding vs other belly binding wraps.

Even, 360 degree support:Bengkung belly binding provides even support from your pelvic bone to your breasts. It can provide the same even amount of support from top to bottom and from back to front . Alternatively, it can be adjusted to be looser at some points and tighter on other spots. Can you get that with the store kind? No, it just isn’t going to be possible. Even if it did compare in this department, there is still so much more to consider!

No Velcro issues:Sometimes Velcro breaks down after multiple uses. You may find the tight fit that you felt at the beginning is starting to wane. Next thing you know, you’re looking for the duct tape to hold it all together. The material that I use for Bengkung belly binding is strong and durable. It holds up wash after wash, and never loses it’s ability to do it’s job. Each wrap is hemmed and surged on all edges to prevent frays. Most importantly, the surged edges DO NOT bunch up or dig into your skin. Comfort is a pretty big deal when you have liquids poring out of every orifice of your body.

Heat:Here in Texas, in the summer it’s HOT and HUMID. As I look at the various binds out there on the market, most have a few things in common. Elastic, and Velcro. No matter how soft and breathable they claim for their bind to be, there certainly is a lot of materials needed to keep the wrap fastened and taught. (Velcro, spandex, elastic, whatever). None of these materials allow the skin to breathe nearly as well as a giant piece of cotton, muslin or batik fabric. Postpartum moms are already sweating after they give birth, no need to turn the faucet on any higher!

More work:Speaking of materials, sweat and heat - what about washing that thing? The ones that you can purchase at the store are almost always going to instruct to hand wash. Yes, HAND WASH, not even use your washer on the ‘hand wash’ setting! It can take 12 hours or so to dry. They encourage purchasing two of them so you can wear one, while the other one is out of commission. You can purchase two Bengkung belly wraps if you’d like, but the one that I provide, is machine washable and most can be washed and dried over night when you aren’t using it anyway. You are already sleep deprived, are you sure you want to add hand washing to your postpartum schedule? (I know you are thinking this could be a job for your mother-in-law, but even she deserves the luxury of using a washing machine)!

A little TLC: When you get your belly bind, it’s not going to ask you how you are doing. It can’t wipe away a tear, while you vomit out how crazy your mother-in-law is making you. It can’t provide you with local resources on breastfeeding, support groups, baby wearing, or whatever you might need. Some women just need to get it all out, and some women just want to do the wrap! Either way, you are getting support. (Slight pun intended). When I come to your home you may just want to get down to business, learn how to wrap and be done. I can do that! I’ll do it as quick as possible, and chat as little as possible. I can be out the door in less than an hour. Some moms would like me to spend more time while they chat and ask lots of questions. They want to talk about their new baby, maybe even ask a question or two about breastfeeding or ask how to use their new pump. As a childbirth educator, a doula, a mom to six, and a breastfeeding counselor, I just might have some answers! I’ll be happy to help you with a breastfeeding session while I’m there. The store bought wraps just don’t compare to a walking birth, postpartum and breastfeeding encyclopedia.

P.S, if your wrap *is* talking to you, you either haven’t slept for a week or you need to contact your health care provider.

So there you have it. You’re a smart consumer! Which one provides you with the best physical and emotional support - while also supporting your local business?

Childbirth classes are not all alike, but much of the information is the same. We all discuss stages of labor, most all will discuss some comfort measures, and provide the rest of the basic topics in various formats. What goes into them beyond that varies widely. I took the basics, combined it with some information that I learned from my doula training, sprinkled in information from all of my other training's, and made the most direct, informative - “I didn’t’ know I needed to know that” childbirth class series I could. I have had many clients come to me for their 2nd or even 3rd births, who have tried various childbirth classes previously, tell me they learned more from me in one class then they ever did in the other classes combined. My classes aren’t any longer than other classes, it’s just that I have the freedom to cut out cheesy games that introduce people to each other, and get things rolling.

Let me tell you what sets my childbirth class series apart from the rest.

The STUFFThere is something for everyone. I have tons of additional information to supplement your classes. Tons of handouts, in the form of a 145+ page binder, colorful booklets if you just want the highlights, and video access for those who just can’t stand to read at all.

The labor tool kit.As far as I know, I am the only person in this area that provides my clients with a labor tool kit to take home and use before, during, and after labor. Clients will be shown how to use the tools in "class two" of the series, and practice again in the final review.

Time and Information:Large classes means less information. The more people in the room, the more time we have to allow for breaks, for questions and answers, and overall instructor content. Because I keep my group classes to a maximum of 4 couples, I can provide more information in the same amount of time. I still have time to answer the various questions, and because the class is more intimate, most everyone feels less shy about asking them as well.

Learning comfort measures is paramount to childbirth education! Even if a mother is planning on an epidural it helps to learn how to cope until she gets it. She also needs a backup plan, in case she can’t have one come labor day. I can’t tell you how many people I have taught my comfort measures class to that did not learn how to do certain things from other childbirth classes. Some of them learned about the techniques but didn’t get to practice them, and everyone says they didn’t learn as many coping techniques over all. I like to show a technique, then let the partner practice so that each mother has an idea of how it is supposed to feel. You just can’t do that in a large class, because you don’t have enough time to do that one-on-one.

OH, and if you are a single mom? I have plenty of tricks to show you how you can do many comfort techniques by yourself!!!

Photo credit: Amanda Gipson Photography

Scheduling:I get calls every day asking when my next childbirth class series starts. Most childbirth classes series have a structured time frame. Most educators teach a group series one day a month, sometimes two days a month. For example they teach every Tuesday on an ongoing basis. Not everyone can make a Tuesday night class. They call around, classes are either full, have started already, or they simply can’t make the night of the week so they forgo classes all together and ‘wing it’.

I teach a childbirth classes every day, excluding Sundays. That's 6 days a week. I teach group classes, and private classes. If you can’t make the next series, or it doesn’t fit your crazy schedule, then take the classes alone, and you will learn a ton in a very relaxed setting! The best part? You pick the time of day we start. I teach classes as early as 8am and starting as late as 8:30pm. Want to know what else? You don’t have to take your classes on the same day every week! You don’t even have to take the class once a week for 5 or 6 weeks. Schedule your classes bi-weekly, once a month, whatever you want, - whatever helps you learn the best. I will always offer to teach your final review closer to your due date if you start early. Speaking of ‘early’. You can start whenever you want. I don’t care if you are 10 weeks pregnant, you can start with my “Early Pregnancy class” and schedule the childbirth class series a couple of weeks after that. Couples often opt to take the first four classes in my childbirth series, and then take the newborn and final review around their 35th and 36th week.

More options! Sometimes people procrastinate. Maybe you didn’t know if you could even give birth vaginally due to a low-lying placenta, or maybe you just had other things to tackle before you could think about giving birth. Suddenly you realize you are 36 weeks and need something quick! I can handle that. I can’t guarantee you’ll get completely finished before you give birth, but I do my best and offer many options. I can sometimes offer to do three classes in a week, or two 5 hour sessions, or one 8 hour session. This especially works if you can accommodate a class during the day. Whatever we can do that works with both of our schedules, and provides you with just the amount of information you need to be prepared.

I keep it current and non-judgmental!I stay up to date on the latest research and evidenced based birth practices. Some childbirth instructors are not allowed to provide any information other than what is ‘in the script’, and even though they know it’s outdated information, they are stuck. I stay current, so you can too!

Hospital based educators have struggles too. (I know I’ve been there). Certain information is ‘not allowed’, and information can be presented in a very different light. For example, some instructors may not tell you that you have more than one option for cervical ripening, because the majority of providers only use one or two methods. You may not learn what a cervical ripening is or for! Information can sometimes be one sided. For example, your instructor might tell you - this is what an epidural is, and this is when to get one. There may not be any discussions about the risks, or benefits to going without one. I once heard of a nurse who told a class that there were no side effects to an epidural and that women were crazy if they considered going without one! You will never hear me tell you that you are crazy - no matter which way you choose to birth. This is your choice! I would like my classes to be a judgement free zone.

Photo credits: Amanda Gipson Photography and Valerie Lopez

My classes are relevant and personal: I have the pleasure of getting to know each and every one of my students. I want to know where they are birthing, who they are birthing with, and what their goals are. I know what their fears are surrounding their upcoming birth . Each person has a unique situation, and in a large group setting you can’t always keep the topics relevant for each person. If I have a group class, I try to group those who are birthing in a hospital setting together, those who are birthing in a birth center together, those who are going for a VBAC together, etc. This way the information is relevant to their situation. There are times when I have a mixed group, but I still remember who is doing what, so that I can tell them when I am talking “this doesn’t apply to you” or “you will have this option, but not this one”. Each person that comes through my door will get information relevant to them. Not everyone wants to go natural, not everyone wants an epidural. Births don’t always go as planned. I provide all the information for both situations, and provide clients with the information to best achieve their birth goals. What they do from there, is up to them!

I know many of the providers in the area. I am familiar with most all the hospital policies. I know if your hospital has a squat bar, or birthing balls, wireless monitoring etc. Many times women who can’t take a childbirth class at the hospital they are birthing at, call around to other hospitals and take a class there. Taking a class ata different hospital can be confusing. It’s cheap, but not relevant. Hospital policies are not the same - even if they are under the same system. It’s important that you understand what is available to you. Since I have worked at most hospitals, I have the inside scoop.

I will provide you with all the tools you need to make your birth the best you can under your specific circumstances. Who doesn't want a well-rounded class relevant to you, non-judgemental, and packed full of the information that you need?!

When people think of childbirth classes, they often think of people learning how to breathe in various patterns, and think that is what childbirth classes are based upon. After all, when you watch TV or a movie, isn’t that what you see? A bunch of people in a circle breathing? These breathing techniques are synonymous with Lamaze childbirth classes (one particular method of teaching childbirth classes). However, there are many types of childbirth classes out there, and Lamaze is only one type. It has been very popular for many years. Some people love it, some people hate it, and I think that one of the factors for this love-hate relationship is that it can be taught so differently from instructor to instructor. Lamaze was very popular in the first 20 years of it’s birth, then lost some popularity in the 80's and 90's and is now making a stronger comeback updating it’s content and class structure.

Here’s the thing: Lamaze is only ONE of many types of childbirth classes out there. Not everyone, including myself teach the various breathing techniques. I want my students to understand three basic principles of breathing: 1) Don’t hold your breath. 2) Breathe in through the nose and out through the mouth to stay calm. 3)Things to try if you can’t push but the urge is strong. If my clients want more breathing techniques, they will have access to those exercises for six months through video content.

Let me say this: I wouldn’t be here if it weren’t for Lamaze. This revolutionized the way women gave birth. They paved the way for childbirth education everywhere. I love the Lamaze six healthy birth practice, and you’ll find those handouts in your binder. I have videos created by Lamaze, and I refer to them often for research articles and evidenced based birth practices. I have a lot of respect for Lamaze, but I am not a Lamaze instructor. I chose to go under an organization that allows me to adjust my content and structure as I need to and keep it my own. I love the fact that I can learn the latest new evidenced based birth practice, and immediately start teaching it in my classes (that very same day if I have the opportunity)!

There are MANY types of childbirth classes out there, for example the Bradley Method is another popular method of childbirth preparation. The list goes on. There are many non-specific childbirth classes that are simply called “Prepared Childbirth”. This is basically a generic term that means we are not affiliated with any certain program. That’s me.

When a person becomes a childbirth educator, they can become an instructor under one of the popular methods, such as a Lamaze Certified Childbirth Educator (LCCE), or they can become a childbirth educator under a non-specific organization (such as Childbirth International). A Lamaze instructor is bound to teach only Lamaze content, but instructors like me can include whatever content we would like (as long as we aren’t stealing other methods’ content of course)! Most educators cannot be certified to teach under one brand while also teaching their own structured classes. In fact you may not be able to teach your own stuff for years after leaving said organization. I couldn’t be confined to one box, so I did my own thing and my students are thriving!

The bottom line:Every childbirth course should have some basic content that is the same.

We all teach the stages of labor. (We just might have a different way of talking about it).

Most all of us will teach basic hospital interventions

Most of all us will discuss and show non-pharmacological coping techniques

The rest of the content will depend on the program that it is based on. You might find one childbirth class series that focus more on nutrition and relaxation, while another focuses on breathing techniques. Some focus on where to birth or how to birth. There are classes that have a little of everything. I fit very well into the “everything” category. No matter where you birth or how you birth, I’ve got relevant information just for you. Oh, and I promise. We won’t be singing Kum Ba Ya. Ever.

Check out my next blog that explains what sets me apart from other childbirth classes!

Tired? It seems to be a common complaint during pregnancy! Your body is working hard growing a baby, and sleep can be harder to accomplish with a growing belly and shrinking bladder. The less we sleep, the more stress we tend to have, and that creates a whole new set of problems. Here are some easy tips to help you sleep better!

Start with a comfortable mattress and get the right pillow support. A good mattress and the right pillow support for your head, and knees can help you fall asleep faster, and keep you from tossing as much at night.

Exercise – not only will that reduce stress, it can increase the deep sleep that will help you reset. Try to avoid exercise within a couple of hours of bedtime. Instead, consider exercising in the morning and early afternoon.

Turn off all the lights. Darkness promotes the production of melatonin. Even a digital clock can disrupt some peoples’ sleep. Most experts recommend reading from books rather than spending time on tablets, or other electronic devices. Avoid grabbing your phone and looking at it as you wind down in bed. Even if you are having trouble falling asleep, this might only make it worse.

Keep your cool. For most people, 65 to 67 degrees Fahrenheit is optimal for sleeping well. (Sorry for those of us who live in Texas). Make sure the fabric on your bed is breath-able so your body heat is not stuck in bed with you. A warm bath is great, and although it can help you feel relaxed, it may not help you fall asleep right away, so consider bath-time at least 2 hours prior to turning in.

Eat sleepy foods. Though you might find you get a better nights rest if you eat lightest at dinner time, sleepy foods might be an added bonus! Foods that are higher in tryptophan help produce melatonin, which is the sleepy “hormone’. Dairy, beans, eggs, oatmeal, turkey, chicken, salmon, tuna, hazelnuts and almonds are among some of the foods high in tryptophan-containing proteins. Just don’t eat too close to bedtime, or heartburn will be keeping you up. Try light snacks high in tryptophan at least 1-2 hours before bed, and sleep on an extra pillow if heartburn gives you trouble.

Hydration is important, and sometimes it is tempting to STOP drinking fluids in the evening so that you aren’t up running to the bathroom every 20 minutes. However, dehydration can cause cramping and an irritable uterus, which can also wake you up, so find a good middle ground. Make sure you are well hydrated in the daytime to help get you through the night. It should go without saying that you should avoid caffeine in the afternoon and evenings to encourage your body to fall asleep faster.

Meditation and/or Prayer. Think positive thoughts. You can use mental imagery, and also practice progressive relaxation at the same time. Breathe slowly in through your nose and out though your mouth to help counteract stress hormones.

Most women start packing their hospital bag as they get closer to delivery. The kitchen sink? No dear, it’s in the RED bag. As a labor partner, your job is to make the laboring mother as comfortable as possible. You have taken the classes, and you’ve got that double-hip squeeze down. You are ready to help her with positioning and your disc-jockey skills are on point! Now it’s time to teach you some of those little labor hacks that might help you look like you’ve secretly been working in labor and delivery your entire life.

The volume button on the fetal monitor:

The volume buttons are usually on the left side of the machine. If you only have one baby - you need only mess with the top set :-)

It can be nice to hear that reassuring sound of your baby’s heartbeat. It’s cute when you hear them hiccup or move around. However, when you are trying to sleep, there is nothing like waking up to a loud “ka-thunk” as your baby kicks the monitor! In a long labor, the same monotonous tones can wear on your nerves after a while and many people are not aware there is a volume button on the monitoring machine. The nurse may need to turn the volume up at first, when she is trying to find the baby’s heartbeat, but after she leaves, it is no longer for her benefit. Don’t worry she is watching your baby’s heartbeat on the monitors at the nurses station. Ask for permission before you start messing with the buttons, but usually a nurse will be happy to show you where the volume button is, and be perfectly fine with you turning it down when you are ready.

A make-shift hair-tie:

Forgot a hair tie to pull back mom’s hair? (She probably didn’t - it’s just that her support person or people can’t find it in one of the hundreds of bags she packed). No problem! You can use a glove to make a hair tie in a pinch. Just break the cuff band away from the glove as carefully as you can, and you should have a ‘rubber band’ to use. It’s not the most glamorous thing in the world, nor is it the strongest hair tie you’ll ever see, but it does the job when you are desperate! See the pictures below for a guideline!

Start with a glove -locate the band at the cuff start separating the cuff from the rest of the glove Done - now get her hair up!

Pushing on the toilet:

Some people don’t even know this is an option, and for some hospitals this isn’t going to happen. However, pushing on the toilet can be very effective. Psychologically, moms relax their bottoms while sitting on the toilet, and that helps baby come down easier. Most moms are not going to push there the entire time and the nurses do not plan to have you deliver there. Since pushing can take a couple of hours (or more) for a first time mom, it’s beneficial to try various positions to help baby rotate and descend. Most nurses in a hospital setting won’t put you on the toilet if they think baby is likely to come there! Still, the thought of baby falling into the toilet will most certainly cross your mind, and this is where the handy towel comes in! Before mom sits down on the toilet, lift the lid and place a towel over the bowl - and put the lid back down. Viola! You now have a ‘safety net’ in place :-) You’re welcome.

Stay tuned, I’ve got more labor and delivery room hacks coming soon!

I give all the following books a 5 star recommendation!

Books on Pregnancy

The Healthy Pregnancy Book by Dr. William (and Martha) Sears is full of great information!

This book has a little bit of everything. It covers all the topics from finding the right health care provider to how to sleep better, eat better, manage stress, and ultimately - how to have a healthier baby and birth!

You may recognize the chapter on "appreciating the hormonal symphony of pregnancy and birth" if you have taken my 2nd class in my childbirth series. Dr. Sears can say it so much better than I can :-)

I have this book in my lending library, but let me tell you now -- you need your own copy! You can always give it to a pregnant friend later, (if you can stand to part with it)!

Pregnancy, Childbirth, and the Newborn (4th Edition): The Complete Guide by Penny Simkin, April Bolding, Ann Keppler, and Janell Durham

Although I have the older version of this book in my lending library, this revised edition has an easier to read format, and is more up to date in the research department. Forget that book everyone tells you they have read (hmm- something about what to expect....:-) -- this is the one book with evidenced-based research, and should be your go-to pregnancy and birth resource! It covers information from pregnancy to newborn care and will compliment any other books you might want to read. Be empowered, be informed, and enjoy this book!

Books on Birth

The Birth Partner -Revised 4th Edition: A Complete Guide to Childbirth for Dads, Doulas, and All Other Labor Companions by Penny Simkin

This is great for moms, but dads seem to really enjoy this 'birth manual'. I've had many dads refuse to pick up a pregnancy or birth related book, and when I ask them to look through this book, they read it cover to cover! (Even if you can't read a book from cover to cover, this book has tab sections, so you can look up information quickly and easily). This is a must for any birth partner to help them understand birth and how to help a laboring mother cope. This book is required reading for many doula organizations for doula certification. Sheila Kitziner sums it nicely; “Penny Simkin shows how giving support in childbirth is not only a matter of helping a woman through labor and delivery—important though that is—but also of enabling her to cherish a meaningful memory of birth.” – Sheila Kitzinger, author of Rediscovering Birth and The Complete Book of Pregnancy and Childbirth

Ina May's Guide to Childbirth by Ina May GaskinBefore I give a summary of the book, I have to tell you a little about Ina May Gaskin. Ina May Gaskin is one the nations' leading midwives, in fact, the obstetric world uses "The Gaskin Maneuver" to help resolve shoulder dystocia (stuck shoulders) in labor - the first obstetrical procedure to be named after midwife. Gaskin has traveled around the world lecturing to both physicians and other midwives. Her midwifery practice on "The Farm" in Tennessee was the first birth center to be founded in the United States -- and has the lowest birth interventions and cesarean rates, and most importantly, mortatility rates in the nation! This was was compared to 14,000 physician attended hospital births (including those typically labelled as high risk) by the published study “The Safety of Home Birth: The Farm Study,” authored by A. Mark Durand, American Journal of Public Health , March, 1992, Vol. 82, 450-452

All that being said, Ina May has a lot of good information to say, and she has many books to say them in. This book is one of the easiest to read, and enjoyed by most everyone! The book starts out with birth stories and continues on about birth, birth practices and safety. Ina May has a way of taking the fear out of childbirth and portraying it as it should be -- a happy, and healthy, normal event.

Okay, I will admit, there are some parts of this book I can't swallow hook, line and sinker, but there is still some great information in a very easy-to-read-format. If you aren't into the art projects that are supposed to help you overcome birth fears, and if the new-age, hippy parts of the book leave a bad taste in your mouth, you can skip to chapter 16 and get some great information on how to cope with labor and birth. There's something for everyone in this book!

The Thinking Woman's Guide to a Better Birth by Henci Goer

Henci Goer wrote her first book, Obstetric Myths Versus Research Realities, in 1995 and it has become a staple for childbirth professionals since. Its successor, Optimal Care in Childbirth: The Case for a Physiologic Approach, written in 2013 -- won the American College of Nurse-Midwives “Best Book of the Year” award. The Thinking Woman's Guide to a Better Birth is loved by birth professionals and parents alike. It explains all the common birth procedures along with their risks and benefits, so it will definitely provide you with all the information you need to build an informed and educated birth plan! Some of the information is slightly outdated, and that is why I cannot stress enough that you should always take a well rounded childbirth class. That being said, this is still probably my most recommended and borrowed book in my library. You are always welcome to borrow it if you don't want to purchase your own. Actually, I have two copies, but be warned: Neither sit on my book shelf very long :-)

Ahhhh...Marsden Wagner. What can I say? I love him. Not in a "I-want-to-marry-you" kinda way, but I just love to hear him talk. I love his passion. Some people cannot stand his somewhat, crass, opinionated manor, and his undoubted bias for natural birth, but maybe that is why I love him! Dr. Marsden was a perinatologist and perinatal epidemiologist and was also the Regional Officer for Maternal and Child Health in the European Regional office of the World Health Organization for 15 years. He knows medical birth and he knows natural birth. He knows how births take place in the hospital and how women give birth at home and in birth centers -- and he makes no bones about which he prefers for low-risk women. This book isn't for everyone, especially if you aren't already aware of birth politics and practices we have here in the US. However, if you tend to be a wee bit cynical, or even have an open mind to the birth crisis we have in America -- and want to make a truly informed birth plan -- read this book! This is one of my personal favorites, but it's not for everyone :-) This is another book I have available in my lending library. Here was the last interview Dr. Wagner did back in 2008 https://www.youtube.com/watch?v=Cm8ErQxTFyo. May his soul rest in peace.

Books on Breastfeeding

The Ultimate Breastfeeding Book of Answers: The Most Comprehensive Problem-Solving Guide to Breastfeeding from the Foremost Expert in North America by Dr. Jack Newman and Teresa Pitman

I read this book during my breastfeeding counselor training, and it was super informative. Dr. Jack Newman is probably the number one expert in the breastfeeding business. Don't ask me how a guy got to know so much about breastfeeding! It's not because he is a pediatrician, because unfortunately most do NOT know much about breastfeeding at all. Maybe it's because he was a father of four breastfed children, but I think it most likely has to do with the fact he has been helping mothers breastfeed for 30-some years. Women, especially here in the US, are afraid they can't breastfeed. There are so many misconceptions, and Dr. Newman gets right down to business dispelling myth after misconception. Dr. Newman will be the first to tell you that breastfeeding is not always easy, but he will also be the first to say most women can breastfeed with the right help and the right information. This book will have answers to all of your questions from how to breastfeed to how to get through common breastfeeding troubles. You will see that I print out many of his handouts and put them in your binder, and are also given in my breastfeeding classes as well. His website is an invaluable resource: http://www.breastfeedinginc.ca/index.php

This book is a classic! Published first in the 1950's this book is now on it's 8th revision, and going strong. It continues to be a number one seller, and has been read by thousands (if not millions) of women! This book is huge (about a hundred more pages than Dr. Jack Newmans book) -- but you don't have to read it cover to cover. Read what you need!Some people are put off by this book claiming it is too judgmental. (It does talk about the benefits of getting the best start by having an unmedicated birth, and it also talks about how going back to work is hard on brestfeeding moms) -- but this book is too good to throw out the baby with the bathwater in my opinion.

So That's What They're For!: The Definitive Breastfeeding Guide by Janet Tamaro

When I had to read what seemed like a hundred books about breastfeeding, during my breastfeeding counselor training, I can tell you I was not looking forward to yet another book! I had read everything from clinical to breastfeeding politics, and I was pretty sure I was going to have trouble staying awake reading the same information yet again. I was pleasantly surprised and instantly captivated by this book! Janet Tamaro was funny, and she was up-to-date! I recommend starting with this book and then adding one of the two other books listed above for more in depth trouble shooting and information. Sometimes it helps to get the same information in a different way, but this book will not be as detailed on the how-to's. Get one of each, take a good breastfeeding class, and get ready to breastfeed!

Books on Baby Care

The Baby Book: Everything You Need to Know About Your Baby from Birth to Age Two by William Sears, Martha Sears, Robert Sears, and James Sears

This is a huge book, and if you only buy one book on babies, this should cover it all for ya! My sister likes to call it the 'baby bible', and she loves to give this book out as a gift to pregnant friends and family. You'll see why...it's huge! It has information on everything! You obviously don't have to read this book from start to finish -- just read up on the information that you need in the moment. Not everything in this book is going to work on your parenting journey, and you may readthings you do not agree with. Some of the advice might even offend some people (attachment parenting, co-sleeping etc). Personally, I have no problem reading through and taking various pieces of advice and adapting it to my own needs, and you can too :-) Even Dr. Sears and his wife talk about how you have to do what is right for your family. This book is still a treasure! There is so much information that is helpful and dare I say necessary to have as a reference -- like how to take a temperature, or ways to get the medicine down that makes it worth every penny. Trust me, you'll wear the cover off this one if you give it half a chance!

The Happiest Baby on the Block by Dr. Harvey Karp

I loved this book so much that I became a Happiest Baby on the Block educator :-) If you want to understand why babies cry, and how to get them to stop crying in seconds, you might want to pick this one up. Dr. Karp has found there IS a remedy for colic and it works for every baby unless there is a medical condition for their crying. Some books will provide information that works for one baby, while a completely different book only works for a different baby. That's why we have so many parents saying "well this worked for me," while another mom is frowning in frustration because that didn't work for her baby! The Happiest Baby will work for everyone, and the solutions are so simple that they are really just techniques done for centuries but sometimes suppressed or forgotten by our modern day society. If you don't want to read the whole thing, that's okay, my Happiest Baby Class will give you the "cliff notes" -- and also receive a parent kit that includes a DVD and Soothing Sounds CD. You'll be ready to proclaim that you are the proud parents of the "Happiest Baby on the Block!"

Other Books:

Pushed: The Painful Truth About Childbirth and Modern Maternity Careby Jennifer Block

Shameful confession here: I've never read this book! So I guess in all fairness I can't give it five stars just yet. I have read bits and pieces while sitting in the library, and what I did read, was awesome! Pushed is more of a political birth book, so it's not going to cover things like stages of labor and things of that nature. This book is about the sorry state of birth in the United States and her research will show the reader how the over-use of technology isn't always best, and tries to shine light on the question "do women have the right to normal birth?" Is the obstetric community letting mothers who are low risk have a normal birth? Do we even know what normal is anymore? I digress. Read this book, and you might understand that birth isn't what you think it is in the land of the free.

The Vaccine Book: Making the Right Decision for Your Child by Robert W. Sears

This book really breaks down the tough decisions about vaccinations. This book is fairly easy to read and Dr. Robert Sears does agreat job of telling you about a particular disease, how common it is, how dangerous (or harmless) it is, and then goes on to cover the vaccination ... from the ingredients of the vaccine, to any possible side effects from the vaccine. The information is presented in an unbiased manner, so you can decide what vaccinations you want for your child and when to get them.

Cut It Out: The C-Section Epidemic in America by Theresa Morris

Another book I'll admit I have not read, but when I saw these videos, I knew I wanted to read the book. It's definitely on my wishlist!

VIDEO:

The Business of Being Born - DVD produced by Ricki Lake and directed by Abby Epstein

This documentary has changed so many peoples lives! I cannot tell you how many of my clients would not have considered a natural childbirth ever ... and then they watched this movie. This movie has commentary from some of the most respected birth professionals in the world (including Dr. Marsden Wagner). It covers the medical and political politics of birth and why the maternity care in the United States is in crisis. Just watch the trailer, and if you like what you see, buy the DVD and show it to all of your friends who are pregnant :-)